Saturday, May 31, 2014

Soapbox Saturday: Collaboration-is it an Urban Legend or Real Threat

Did you know that my friend's friend's cousin's brother went to a local fast food chicken restaurant and when he went to bite into his chicken leg there was a tail sticking out of it?

That is one of my favorite urban legends.  It's so gross to think that you would accidentally eat a cooked rat.  I'm fascinated by these.  One of the spookiest that I remember was the one about the college roommate who was heading out to the library.  She forgot her book so she ran back in the room but didn't turn on the light.  After she finished studying, she came back to find that the police were at her dorm.  Her roommate had been murdered.  Written on the wall in her blood were the words: "Aren't you glad that you didn't turn on the light?"

That will probably win the award for the most gruesome Speech therapy blog intro.  I find Urban legends fascinating.  Another favorite story of mine is the one about a woman who always cuts off both ends of a roast when she is cooking it.  Someone asks her  why she does that and she responds that her mother always did that.  She asks her mother and she responds that that's how her grandmother fixed it.  They ask the grandmother and she tells them that she had to cut off both ends of the roast because her pan was too small.

Did you hear the one about the friend of a cousin of an aunt of a family who worked for a principal's nephew?  His speech pathologist told them that they might need more speech therapy.  The parents went to court and sued the school district and now they have to pay for private speech therapy and to do that they had to lay off 15 speech teachers.

I'm not really saying that this is an urban myth-but I'm also wondering how many lawsuits were filed where the district had to pay for private speech therapy because of a recommendation for more services.  It's probably not a good idea to recommend additional services in the school.  Instead, you could ask if they receive outpatient services.  If the parents ask what that is, you could say that some parents are able to receive additional services through their medical insurance.  When parents are requesting things that aren't possible in the schools, you could also mention that some parents choose to receive additional services which are billed to their medical insurance.  

I work at a clinic as well as within the schools.  Most of my clients or students do better when they are able to access both therapies.  We learn about the importance of collaboration in graduate school.  But when we get out into the "real world," we sometimes find that collaboration (or at least referrals) is discouraged.

I think students do better when they have access to both services for several reasons.  They are able to practice (typically in a group setting) at their school with their peers.  The school speech language pathologist has access to the teachers and can help to incorporate generalization of these skills with indirect services over an entire school day.  Private therapy is typically conducted in one on one settings.  The student receives intensive services and can achieve multiple repetitions of a target.  One on one can be especially effective for middle to high school students who tend to have "attitude" within a group setting.  The private therapist is generally able to coordinate on a weekly basis with the child's family working on carryover to the home environment.  The student benefits by practicing his or her skills in more than one setting with more than one professional which helps to increase the likelihood of carryover of skills to all environments.

Awhile ago I put on my school speech language pathologist hat to talk about how unhelpful it is when private therapists try to make a million recommendations for how you should do your job.  Today, I'm going to put on my clinic hat.

Here is what is most frustrating.  People don't know that there is an option to access speech therapy through their medical insurance.  It saddens me when I have a client come in at 16 whose parents didn't realize that they could access additional services.  Coming in at a close second is insurance plans who deny coverage for speech therapy or articulation therapy.  Or the plans who only cover services until age 5.

Students who no longer meet educational criteria for speech and language services may still benefit from one on one private speech therapy.  Students who haven't yet qualified for articulation services may be able to access habilative therapy sooner.

Doctors are thought to be the main referral sources for outpatient services but they often hesitate to recommend additional services.  In general, they do not understand how school coverage works.  I've had doctors who've refused to sign orders because they wanted the parents to access school services for a patient who wouldn't qualify for school services for two more years.

Schools sometimes seem to be the missing link in getting children access to all of their community resources.  The school speech and language pathologist is probably going to have some type of contact with most children who need or would benefit from speech and language services.  One of the bigger challenges for private clinics is how to get the information to families that there are additional community resources for speech and language intervention.  Many families will choose not to access these services for a variety of reasons-including insurance coverage, financial cost or an inability to devote the extra time to outpatient therapy.  I don't think I expect that every student should get private therapy nor do I think that every student needs private therapy.  But I just wish that each family knew that private therapy exists.  That's where I could really use the help of my School Speech Language Pathologist friends.

Next week I'm going to talk a little bit more about how collaboration benefits both school and outpatient therapy clinics and also how we can make that collaboration successful.

I'd love to hear your thoughts (good or bad) on this topic!  You can comment below.  If you thought this was particularly interesting or relevant, please think about sharing this post with others by using the social media buttons below.

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